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CDC link on rationale for Hep B vax for infants - Page 3

post #41 of 49

Ummm...Just wanted to say something here that might cause everyone to stop and think.  If a mother is identified with a Hep B infection prenatally, it is unknown if she will transmit it to the infant.  In these cases it is NOT the Hep B vaccine that is recommended, but the HBIG (immunoglobulin) shot.  It is still recommended that the baby gets 3 doses of the Hep B vaccine to prevent FUTURE transmission from the mother out of utero (such as through breastmilk or blood) but the birth dose of Hep B vaccine does not exist to protect the baby from in utero exposure.  Only HBIG can do that.  It's not known what percentage of babies born to Hep B positive mothers will be born with Hep B, but the (sensible) CDC protocol is to give HBIG to them all.  (And Hep B vaccine to cover future exposure, however if they are going to be immediately adopted, and not going to be further exposed to the mother so might not have any greater risk factor to get Hep B in the future, it is not actually needed.)

 

Think about it if you brought your unvaccinated child to the ER with a tetanus possible wound.  They would give them the immunoglobulin (TIG) for the existing wound, then a dose of tetanus containing vaccine (for later wounds, in hope that you would complete the other 2 doses for the series.)  It works the same.

 

I know this because I am a midwife and we had a woman with Hep B when I was a student.  It was my job to research what to do and how to obtain HBIG for a birth center birth (next to impossible, she eventually had to transfer for a hospital birth just for the HBIG availability).

post #42 of 49

So what I was trying to say is that the birth dose does not exist to protect babies from getting active Hep B infection from their Hep B positive mothers.  It exists to protect them from LATER (external to the uterus) exposure.  So I still don't understand why the primary injection is given at birth to babies who have little risk factors.  Why not just do the first one at 2 months of age like we do for DTaP?  Or later? 

post #43 of 49
That's interesting nuku, that's not what I had read before. It was my understanding that the birth shot was to protect the baby from transmission at birth. Sounds like I need to do some more reading.
post #44 of 49

I didn't know it either until faced with the situation, and neither did the midwives I worked with, because it's rare to have a client with active Hep B.

 

Here is a huge amount of info if you are interested:

http://www.immunize.org/askexperts/experts_hepb.asp

 

Scroll down to where it says "Pregnancy, perinatal, and infant hepatitis B issues".

 

I'd imagine that most OBs might know about HBIG who work with a more high risk population than us homebirth midwives, I hope they do at least!

post #45 of 49
I had always read that the birth dose was to protect from transmission from mom, but I guess I misunderstood and it meant transmission in those first days and not in utero. Either way, thanks for the knowledge!
post #46 of 49

No problem!  I love getting correct and exact information, I imagine you are a lot like me in that aspect, even though our vaccine choices differ.

post #47 of 49
Gosh Nia, I was thinking you were saying she was a healthcare professional living in Asia! Dunno about Germany - I suppose they are acting in a cautious, feelgood sort of way. I'm sure a lot of countries like the US find that since anamnastic response in the absence of antibody levels has been shown to offer protection for at least 20 years in initial responders so the cost isn't really justified.
Quote:
Originally Posted by nukuspot View Post

Ummm...Just wanted to say something here that might cause everyone to stop and think.  If a mother is identified with a Hep B infection prenatally, it is unknown if she will transmit it to the infant.  In these cases it is NOT the Hep B vaccine that is recommended, but the HBIG (immunoglobulin) shot.  It is still recommended that the baby gets 3 doses of the Hep B vaccine to prevent FUTURE transmission from the mother out of utero (such as through breastmilk or blood) but the birth dose of Hep B vaccine does not exist to protect the baby from in utero exposure.  Only HBIG can do that.  It's not known what percentage of babies born to Hep B positive mothers will be born with Hep B, but the (sensible) CDC protocol is to give HBIG to them all.  (And Hep B vaccine to cover future exposure, however if they are going to be immediately adopted, and not going to be further exposed to the mother so might not have any greater risk factor to get Hep B in the future, it is not actually needed.)

Sure HBIG protects somewhat in the immediate period but it is BOTH vaccine and HBIG that are recommended not just HBIG. So why also give vaccine to those babies born to positive/unknown status mothers? Because if you're going to intervene, you want it to work & HBIG alone isn't adequate to achieve the goal of preventing infant infection. "For an infant with perinatal exposure to an HBsAg-positive and HBeAg-positive mother, a regimen combining one dose of Hepatitis B Immune Globulin (Human) at birth with the hepatitis B vaccine series started soon after birth is 85%–95% effective in preventing development of the HBV carrier state. Regimens involving either multiple doses of Hepatitis B Immune Globulin (Human) alone or the vaccine series alone have 70%–90% efficacy, while a single dose of Hepatitis B Immune Globulin (Human) alone has only 50% efficacy." Babies born to mothers with a high viral load are going to need all the help they can get.
post #48 of 49
Where is that quote from? When we researched it we just found the rec was HBIG alone. But no matter what, even if the best rec is HBIG plus hep B vaccine, this is for hep B positive mamas and their babies. It still makes little sense to me to start the Hep B series in an hours old newborn for those babies that are not at risk?
post #49 of 49
Just click on it - it's from the Talecris HBIG PI but it's on the NabiHB PI as well. I'm sure you can also find it in some of the MMWRs, particularly the ones from the late 80s-early 90s.

I personally agree with you that a birth dose isn't so necessary for infants born to negative moms & I think all negative families should easily be able to make an informed choice to decline. As I mentioned previously, the rationale of that strategy is to create a system less likely to miss babies due to the severity of the consequences: "because errors or delays in documenting, testing, and reporting maternal HBsAg status can and do occur, administering the first dose of Hepatitis B vaccine soon after birth to all infants acts as a safety net." I've had situations where HBIG was given to the wrong baby in the nursery & once it was even given to the mom. I've also had incorrect labs ordered or results misinterpreted numerous times. I'm not saying I think the current US strategy is the right/wrong/best approach but from the perspective of TPTB, it's considered to be of greater benefit to vax babies that might not be high risk than it is to miss ones that need it.
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